Impact of white matter hyperintensities on the prognosis of cryptogenic stroke patients

Seong Ho Jeong, Sung Soo Ahn, Minyoul Baik, Ki Hoon Kim, Joon Sang Yoo, Kyoungsub Kim, Hye Sun Lee, Jimin Ha, Young Dae Kim, Jihoe Heo, Hyo Suk Nam

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background To our knowledge, little is known regarding whether white matter hyperintensities (WMH) affect the prognosis of cryptogenic stroke (CS) patients. Understanding this association may be helpful with expecting the prognosis of CS patients. Methods This retrospective observational study enrolled consecutive CS patients who underwent brain MRI and comprehensive cardiac evaluation. Severe WMH was defined as Fazekas’ score 3. We defined poor functional outcome as modified Rankin Scale score 3 at 3 months. Long-term mortality and causes of death were identified using national death certificates and assessed by Kaplan-Meier method and regression analysis model. Results Among 2732 patients with first-ever ischemic stroke, 599 (21.9%) patients were classified as having CS. After exclusions, 235 patients were enrolled and followed up for a median of 7.7 years (IQR, 6.7–9.0). Severe WMH were found in 81 (34.5%) patients. After adjustments, severe WMH were an independent predictor for poor functional outcomes at 3 months (OR 5.25, 95% CI, 2.07–13.31). Subgroup analysis showed that severe WMH were an independent predictor for long-term mortality only in younger patients (age < 65) (HR 3.11, 95% CI, 1.29–7.50), but not in older patients (HR 1.19, 95% CI, 0.63–2.23). Conclusions Severe WMH were independently associated with short-term functional outcomes in CS patients and independently associated with long-term mortality in younger CS patients. Grading WMH is of value in predicting prognosis of CS patients with young age.

Original languageEnglish
Article numbere0196014
JournalPloS one
Volume13
Issue number4
DOIs
Publication statusPublished - 2018 Apr 1

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stroke
Regression analysis
Magnetic resonance imaging
prognosis
Brain
Stroke
Mortality
White Matter
death
Death Certificates
Kaplan-Meier Estimate
observational studies
Observational Studies
Cause of Death
regression analysis
Retrospective Studies
Regression Analysis
brain

All Science Journal Classification (ASJC) codes

  • Biochemistry, Genetics and Molecular Biology(all)
  • Agricultural and Biological Sciences(all)

Cite this

Jeong, S. H., Ahn, S. S., Baik, M., Kim, K. H., Yoo, J. S., Kim, K., ... Nam, H. S. (2018). Impact of white matter hyperintensities on the prognosis of cryptogenic stroke patients. PloS one, 13(4), [e0196014]. https://doi.org/10.1371/journal.pone.0196014
Jeong, Seong Ho ; Ahn, Sung Soo ; Baik, Minyoul ; Kim, Ki Hoon ; Yoo, Joon Sang ; Kim, Kyoungsub ; Lee, Hye Sun ; Ha, Jimin ; Kim, Young Dae ; Heo, Jihoe ; Nam, Hyo Suk. / Impact of white matter hyperintensities on the prognosis of cryptogenic stroke patients. In: PloS one. 2018 ; Vol. 13, No. 4.
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abstract = "Background To our knowledge, little is known regarding whether white matter hyperintensities (WMH) affect the prognosis of cryptogenic stroke (CS) patients. Understanding this association may be helpful with expecting the prognosis of CS patients. Methods This retrospective observational study enrolled consecutive CS patients who underwent brain MRI and comprehensive cardiac evaluation. Severe WMH was defined as Fazekas’ score 3. We defined poor functional outcome as modified Rankin Scale score 3 at 3 months. Long-term mortality and causes of death were identified using national death certificates and assessed by Kaplan-Meier method and regression analysis model. Results Among 2732 patients with first-ever ischemic stroke, 599 (21.9{\%}) patients were classified as having CS. After exclusions, 235 patients were enrolled and followed up for a median of 7.7 years (IQR, 6.7–9.0). Severe WMH were found in 81 (34.5{\%}) patients. After adjustments, severe WMH were an independent predictor for poor functional outcomes at 3 months (OR 5.25, 95{\%} CI, 2.07–13.31). Subgroup analysis showed that severe WMH were an independent predictor for long-term mortality only in younger patients (age < 65) (HR 3.11, 95{\%} CI, 1.29–7.50), but not in older patients (HR 1.19, 95{\%} CI, 0.63–2.23). Conclusions Severe WMH were independently associated with short-term functional outcomes in CS patients and independently associated with long-term mortality in younger CS patients. Grading WMH is of value in predicting prognosis of CS patients with young age.",
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Jeong, SH, Ahn, SS, Baik, M, Kim, KH, Yoo, JS, Kim, K, Lee, HS, Ha, J, Kim, YD, Heo, J & Nam, HS 2018, 'Impact of white matter hyperintensities on the prognosis of cryptogenic stroke patients', PloS one, vol. 13, no. 4, e0196014. https://doi.org/10.1371/journal.pone.0196014

Impact of white matter hyperintensities on the prognosis of cryptogenic stroke patients. / Jeong, Seong Ho; Ahn, Sung Soo; Baik, Minyoul; Kim, Ki Hoon; Yoo, Joon Sang; Kim, Kyoungsub; Lee, Hye Sun; Ha, Jimin; Kim, Young Dae; Heo, Jihoe; Nam, Hyo Suk.

In: PloS one, Vol. 13, No. 4, e0196014, 01.04.2018.

Research output: Contribution to journalArticle

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T1 - Impact of white matter hyperintensities on the prognosis of cryptogenic stroke patients

AU - Jeong, Seong Ho

AU - Ahn, Sung Soo

AU - Baik, Minyoul

AU - Kim, Ki Hoon

AU - Yoo, Joon Sang

AU - Kim, Kyoungsub

AU - Lee, Hye Sun

AU - Ha, Jimin

AU - Kim, Young Dae

AU - Heo, Jihoe

AU - Nam, Hyo Suk

PY - 2018/4/1

Y1 - 2018/4/1

N2 - Background To our knowledge, little is known regarding whether white matter hyperintensities (WMH) affect the prognosis of cryptogenic stroke (CS) patients. Understanding this association may be helpful with expecting the prognosis of CS patients. Methods This retrospective observational study enrolled consecutive CS patients who underwent brain MRI and comprehensive cardiac evaluation. Severe WMH was defined as Fazekas’ score 3. We defined poor functional outcome as modified Rankin Scale score 3 at 3 months. Long-term mortality and causes of death were identified using national death certificates and assessed by Kaplan-Meier method and regression analysis model. Results Among 2732 patients with first-ever ischemic stroke, 599 (21.9%) patients were classified as having CS. After exclusions, 235 patients were enrolled and followed up for a median of 7.7 years (IQR, 6.7–9.0). Severe WMH were found in 81 (34.5%) patients. After adjustments, severe WMH were an independent predictor for poor functional outcomes at 3 months (OR 5.25, 95% CI, 2.07–13.31). Subgroup analysis showed that severe WMH were an independent predictor for long-term mortality only in younger patients (age < 65) (HR 3.11, 95% CI, 1.29–7.50), but not in older patients (HR 1.19, 95% CI, 0.63–2.23). Conclusions Severe WMH were independently associated with short-term functional outcomes in CS patients and independently associated with long-term mortality in younger CS patients. Grading WMH is of value in predicting prognosis of CS patients with young age.

AB - Background To our knowledge, little is known regarding whether white matter hyperintensities (WMH) affect the prognosis of cryptogenic stroke (CS) patients. Understanding this association may be helpful with expecting the prognosis of CS patients. Methods This retrospective observational study enrolled consecutive CS patients who underwent brain MRI and comprehensive cardiac evaluation. Severe WMH was defined as Fazekas’ score 3. We defined poor functional outcome as modified Rankin Scale score 3 at 3 months. Long-term mortality and causes of death were identified using national death certificates and assessed by Kaplan-Meier method and regression analysis model. Results Among 2732 patients with first-ever ischemic stroke, 599 (21.9%) patients were classified as having CS. After exclusions, 235 patients were enrolled and followed up for a median of 7.7 years (IQR, 6.7–9.0). Severe WMH were found in 81 (34.5%) patients. After adjustments, severe WMH were an independent predictor for poor functional outcomes at 3 months (OR 5.25, 95% CI, 2.07–13.31). Subgroup analysis showed that severe WMH were an independent predictor for long-term mortality only in younger patients (age < 65) (HR 3.11, 95% CI, 1.29–7.50), but not in older patients (HR 1.19, 95% CI, 0.63–2.23). Conclusions Severe WMH were independently associated with short-term functional outcomes in CS patients and independently associated with long-term mortality in younger CS patients. Grading WMH is of value in predicting prognosis of CS patients with young age.

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